Rental Car Indemnity Form

First Name*

Last Name*

Home Address

Street*

Suburb*

State*

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Local Address - (to be completed if you are not from Queensland. The address of where you are staying while in Queensland)

Street Address

Suburb

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Email*

Phone Number*

Vehicle Requirements - Small or Medium Sized Car?
SmallMedium

Vehicle Requirements - Automatic or Manual?
AutomaticManual

Area of Operation/Tolls*

Licence Number*

Licence Expiry Date (DD/MM/YYYY)*

Date of Birth (DD/MM/YYYY)*

Payment Method* (note: payments by credit card attract a 3% surcharge. No surcharge for EFT payments)
CashEFTCard

Credit Card Number*
We require a $100 deposit to secure your booking. This fee is not refundable and will be deducted from the total cost of the hire.

Credit Card Expiry*

Credit Card CCV*

Do you give us permission to charge your Credit Card hire costs?

Pick Up Date*

Pick Up Time*

Estimated Return Date*

Estimated Return Time*

24HR Day Rate: $50

Per Kilometre Rate: 20 cents

Photo of Driver Licence (front)*

Photo of Driver Licence (back)*

• Minimum car hire is 3 days. You can still rent for 1 or 2 days, but the minimum charge is $150.
• Property damage to this car or any other persons property is YOUR RESPONSIBILTY
• This vehicle only has CTP insurance. Card Refunds Take 5 Bank Days
• You are responsible for any financial loss, infringements, damage & tolls.
• Car Total Loss Repair/Replacement Maximum Cost $12000
• A fee can be charged for down time during car repairs
• CARS MUST BE WASHED PRIOR TO RETURN. Otherwise is $55 min charge
• CAR WASH END OF OUR STREET WITH VACUUM FACILITIES
• Interior or exterior damage charged at repair costs
• Cars are NON SMOKING, cleaning fees will apply. $250 minimum
• Tolls will be automatically charged to your credit card
• Infringement notices will incur a $100 admin fee to transfer to your license
• There is no roadside assistance or recovery. You can be charged for at fault issues
• Rent in advance & ks costs must be paid weekly. Weekly odometer pics please
• You authorize us to use the supplied credit card for rental costs
• We require a $100 deposit to secure your booking. This fee is not refundable and will be deducted from the total cost of the hire.

Renter Full Name*

Date*

By clicking submit below, you confirm you have read and agree to all the Terms and Conditions above.

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